Surgical instrument with end-effector assembly including three jaw members

ABSTRACT

A surgical device includes an elongated shaft having an end-effector assembly at a distal end thereof. The end-effector assembly includes first, second and third jaw members. The first and second jaw members controllably movable from a first position, wherein the first and second jaw members are disposed in spaced relation relative to the third jaw member disposed therebetween, to a second position, wherein the first, second and third jaw members cooperate to grasp tissue therebetween. The surgical device also includes a knife operatively coupled to the elongated shaft. A channel defined along a length of an upper surface of the third jaw member is configured to slideably receive a portion of the knife therein.

CROSS REFERENCE TO RELATED APPLICATION

The present application claims the benefit of and priority to U.S.Provisional Application Ser. No. 61/910,657, filed on Dec. 2, 2013, theentire contents of which are incorporated herein by reference.

BACKGROUND

1. Technical Field

The present disclosure relates to surgical instruments such aselectrosurgical and ultrasonic devices. More particularly, the presentdisclosure relates to surgical instruments that include an end-effectorassembly including first and second jaw members capable of applying acombination of mechanical clamping pressure and energy to effectivelyseal tissue and a third jaw member disposed between the first and secondjaw members configured to sever tissue between the sealed tissue areas.

2. Discussion of Related Art

Electrosurgical and ultrasonic devices have become widely used bysurgeons. Electrosurgery involves the application of thermal and/orelectrical energy to cut, dissect, ablate, coagulate, cauterize, seal orotherwise treat biological tissue during a surgical procedure.Electrosurgery is typically performed using an electrosurgical generatoroperable to output energy and a handpiece including a surgicalinstrument (e.g., end effector) adapted to transmit energy to a tissuesite during electrosurgical procedures. Electrosurgery can be performedusing either a monopolar or a bipolar instrument.

The basic purpose of both monopolar and bipolar electrosurgery is toproduce heat to achieve the desired tissue/clinical effect. In monopolarelectrosurgery, devices use an instrument with a single, activeelectrode to deliver energy from an electrosurgical generator to tissue,and a patient return electrode or pad that is attached externally to thepatient (e.g., a plate positioned on the patient's thigh or back) as themeans to complete the electrical circuit between the electrosurgicalgenerator and the patient. When the electrosurgical energy is applied,the energy travels from the active electrode, to the surgical site,through the patient and to the return electrode.

In bipolar electrosurgery, both the active electrode and returnelectrode functions are performed at the site of surgery. Bipolarelectrosurgical devices include two electrodes that are located inproximity to one another for the application of current between theirsurfaces. Bipolar electrosurgical current travels from one electrode,through the intervening tissue to the other electrode to complete theelectrical circuit. Bipolar instruments generally include end-effectors,such as grippers, cutters, forceps, dissectors and the like.

Forceps utilize mechanical action to constrict, grasp, dissect and/orclamp tissue. By utilizing an electrosurgical forceps, a surgeon canutilize both mechanical clamping action and electrosurgical energy toeffect hemostasis by heating the tissue and blood vessels to cauterize,coagulate/desiccate, seal and/or divide tissue. Bipolar electrosurgicalforceps utilize two generally opposing electrodes that are operablyassociated with the inner opposing surfaces of the end effectors andthat are both electrically coupled to an electrosurgical generator. Inbipolar forceps, the end-effector assembly generally includes opposingjaw assemblies pivotably mounted with respect to one another. In abipolar configuration, only the tissue grasped between the jawassemblies is included in the electrical circuit. Because the returnfunction is performed by one jaw assembly of the forceps, no patientreturn electrode is needed.

By utilizing an electrosurgical forceps, a surgeon can cauterize,coagulate/desiccate and/or seal tissue and/or simply reduce or slowbleeding by controlling the intensity, frequency and duration of theelectrosurgical energy applied through the jaw assemblies to the tissue.During the sealing process, mechanical factors such as the pressureapplied between opposing jaw assemblies and the gap distance between theelectrically-conductive tissue-contacting surfaces (electrodes) of thejaw assemblies play a role in determining the resulting thickness of thesealed tissue and effectiveness of the seal.

A variety of types of end-effector assemblies have been employed forvarious types of surgery, e.g., electrosurgery using a variety of typesof monopolar and bipolar electrosurgical instruments.

SUMMARY

A continuing need exists for a reliable surgical instrument that assistsin gripping, manipulating and holding tissue prior to and duringactivation and dividing of the tissue. A need exists for surgicalinstruments with an end-effector assembly suitable for use with avariety of energy sources.

According to an aspect of the present disclosure, a surgical device isprovided. The surgical device includes an elongated shaft having anend-effector assembly at a distal end thereof. The end-effector assemblyincludes first, second and third jaw members. The first and second jawmembers controllably movable from a first position, wherein the firstand second jaw members are disposed in spaced relation relative to thethird jaw member disposed therebetween, to a second position closer tothe third jaw member, wherein the first, second and third jaw memberscooperate to grasp tissue therebetween. The surgical device alsoincludes a knife operatively coupled to the elongated shaft. A channeldefined along a length of an upper surface of the third jaw member isconfigured to slideably receive a portion of the knife therein.

According to another aspect of the present disclosure, an end-effectorassembly operatively coupled to a shaft is provided. The end-effectorassembly includes movable first, second and third jaw members. The firstand second jaw members are pivotably mounted with respect to oneanother. The third jaw member is disposed between the first and secondjaw members. The first and second jaw members are configured to becontrollably movable from a first position, wherein the first and secondjaw members are disposed in spaced relation relative to the third jawmember, to a second position closer to the third jaw member, wherein thefirst, second and third jaw members cooperate to grasp tissuetherebetween. A channel is defined along a length of an upper surface ofthe third jaw member and configured to slideably receive a portion of aknife therein.

According to another aspect of the present disclosure, an end-effectorassembly operatively coupled to an elongated shaft is provided. Theend-effector assembly includes movable first, second and third jawmembers. The first and second jaw members are pivotably mounted withrespect to one another. The third jaw member is disposed between thefirst and second jaw members. The first and second jaw members areconfigured to be controllably movable from a first position, wherein thefirst and second jaw members are disposed in spaced relation relative tothe third jaw member, to a second position, wherein the first, secondand third jaw members cooperate to grasp tissue therebetween. A cuttingmember is disposed on an upper surface of the third jaw member.

BRIEF DESCRIPTION OF THE DRAWINGS

Objects and features of the presently-disclosed surgical instruments andend-effector assemblies including three jaw members for use in surgicalinstruments to grasp, seal, and/or cut tissue will become apparent tothose of ordinary skill in the art when descriptions of variousembodiments thereof are read with reference to the accompanyingdrawings, of which:

FIG. 1 is a right, side view of a surgical instrument showing a housing,a rotatable member, a shaft, and an end-effector assembly includingthree jaw members in accordance with an embodiment of the presentdisclosure;

FIG. 2A is an enlarged, perspective view of a portion of the shaft andthe end-effector assembly of the surgical instrument of FIG. 1 showingthe end-effector assembly disposed in an open configuration, wherein thefirst and second jaw members are spaced apart from the third jaw memberdisposed therebetween, in accordance with an embodiment of the presentdisclosure;

FIG. 2B is an enlarged, perspective view of the end-effector assembly ofFIG. 2A showing the third jaw member disposed downwardly at a firstangle, e.g., relative to a longitudinal axis defined by the shaft, inaccordance with an embodiment of the present disclosure;

FIG. 3 is an enlarged, perspective view of the end-effector assembly ofFIG. 1 disposed in the configuration shown in FIG. 2B, shown with tissuedisposed below the lower surfaces of the first and second jaw membersand tissue overlying the cutting member outwardly extending from theupper surface of the third jaw member, in accordance with an embodimentof the present disclosure;

FIG. 4 is an enlarged, perspective view of the end-effector assembly ofFIG. 1 disposed in the configuration shown in FIG. 2A, shown with tissuedisposed between the electrically-conductive tissue-engaging surfaces ofthe third jaw member and the electrically-conductive tissue-engagingsurfaces of the first and second jaw members, respectively, and tissueoverlying the cutting member outwardly extending from the upper surfaceof the third jaw member, in accordance with an embodiment of the presentdisclosure;

FIG. 5 is an enlarged, perspective view of the end-effector assembly ofFIG. 4 showing the first and second jaw members in a closedconfiguration with tissue in compression disposed between theelectrically-conductive tissue-engaging surfaces of the third jaw memberand the electrically-conductive tissue-engaging surfaces of the firstand second jaw members, respectively, shown with tissue in tensionoverlying the cutting member outwardly extending from the upper surfaceof the third jaw member, in accordance with an embodiment of the presentdisclosure;

FIG. 6 is an enlarged, end view of the end-effector assembly of FIG. 5showing the first and second jaw members in a closed configuration withsealed tissue in compression disposed between theelectrically-conductive tissue-engaging surfaces of the third jaw memberand the electrically-conductive tissue-engaging surfaces of the firstand second jaw members, respectively, shown with tissue severed into twoportions by the cutting member, in accordance with an embodiment of thepresent disclosure;

FIG. 7 is an enlarged, perspective view of a portion of a surgicalinstrument including an elongated shaft, a knife including a knifeblade, and an end-effector assembly including first and second jawmembers shown spaced apart from a third jaw member disposedtherebetween, shown with the knife blade disposed within the distal endportion of the shaft, in accordance with an embodiment the presentdisclosure;

FIG. 8 is an enlarged, perspective view of the end-effector assembly ofFIG. 7 showing the third jaw member disposed downwardly at a firstangle, shown with tissue overlying the upper surface of the third jawmember, in accordance with an embodiment of the present disclosure;

FIG. 9 is an enlarged, perspective view of the end-effector assembly ofFIG. 8 showing the first and second jaw members in a closedconfiguration with sealed tissue in compression disposed between theelectrically-conductive tissue-engaging surfaces of the third jaw memberand the electrically-conductive tissue-engaging surfaces of the firstand second jaw members, respectively, shown with the knife partiallyextended along a portion of the upper surface of the third jaw member,in accordance with an embodiment of the present disclosure;

FIG. 10 is an enlarged, perspective view of the end-effector assembly ofFIG. 9 showing the knife blade positioned distal to tissue severed intotwo portions disposed above the sealed tissue in compression inaccordance with an embodiment of the present disclosure;

FIG. 11 is an enlarged, perspective view of an elongated shaft, a knifecover defining an interior cavity, a knife including a knife bladedisposed within the interior cavity, and an end-effector assemblyincluding first and second jaw members shown spaced apart from a thirdjaw member disposed therebetween in accordance with an embodiment of thepresent disclosure;

FIG. 12 is an enlarged, perspective view of the end-effector assembly ofFIG. 11, showing the first and second jaw members in a closedconfiguration with sealed tissue disposed between theelectrically-conductive tissue-engaging surfaces of the third jaw memberand the electrically-conductive surfaces of the first and second jawmembers, respectively, and severed tissue disposed above the third jawmember, showing the knife blade positioned distal to tissue severed intotwo portions disposed above the sealed tissue in compression, inaccordance with an embodiment of the present disclosure;

FIG. 13 is an enlarged, end view of a surgical instrument including anend-effector assembly including first and second jaw members shown in aclosed configuration with a third jaw member disposed therebetween,showing a cutting member disposed on the upper surface the third jawmember and extending outwardly therefrom, in accordance with anembodiment of the present disclosure;

FIG. 14 is an enlarged, perspective view of the end-effector assembly ofFIG. 13 showing the first and second jaw members spaced apart from thethird jaw member disposed therebetween in accordance with an embodimentof the present disclosure;

FIG. 15 is an enlarged, perspective view of the end-effector assembly ofFIG. 14 showing the third jaw member disposed downwardly at a firstangle, shown with tissue overlying the cutting member, in accordancewith an embodiment of the present disclosure;

FIG. 16 is an enlarged, perspective view of the end-effector assembly ofFIG. 15 disposed in the configuration shown in FIG. 14 showing tissuedisposed between the electrically-conductive tissue-engaging surfaces ofthe third jaw member and the electrically-conductive tissue-engagingsurfaces of the first and second jaw members, respectively, and tissueoverlying the cutting member in accordance with an embodiment of thepresent disclosure;

FIG. 17 is an enlarged, perspective view of the end-effector assembly ofFIG. 16 showing the first and second jaw members in a closedconfiguration with sealed tissue in compression disposed between theelectrically-conductive tissue-engaging surfaces of the third jaw memberand the electrically-conductive tissue-engaging surfaces of the firstand second jaw members, respectively, shown with partially-severedtissue in tension disposed above the third jaw member, in accordancewith an embodiment of the present disclosure; and

FIG. 18 is an enlarged, perspective view of the end-effector assembly ofFIG. 17 showing the third jaw member disposed upwardly at a secondangle, shown with tissue severed into two portions disposed above theupper surface the third jaw member, in accordance with an embodiment ofthe present disclosure.

FIG. 19A is an enlarged, schematic view of an end-effector assemblydisposed in an open configuration, wherein the first and second jawmembers are spaced apart from one another and positioned above the thirdjaw member, in accordance with an embodiment of the present disclosure;

FIG. 19B is an enlarged, schematic view of the end-effector assembly ofFIG. 19A showing the first, second and third jaw members in a closedconfiguration in accordance with an embodiment of the presentdisclosure;

FIG. 20 is an enlarged, perspective view of the end-effector assembly ofFIG. 19A shown with tissue disposed below lower surfaces of the firstand second jaw members and tissue overlying an upper surface of thethird jaw member in accordance with an embodiment of the presentdisclosure;

FIG. 21 is an enlarged, perspective view of the end-effector assembly ofFIG. 20 showing the first and second jaw members in a closedconfiguration with tissue in compression disposed betweenelectrically-conductive tissue-engaging surfaces of the third jaw memberand the electrically-conductive tissue-engaging surfaces of the firstand second jaw members, respectively, shown with tissue in tensionoverlying the upper surface of the third jaw member, in accordance withan embodiment of the present disclosure;

FIG. 22A is an enlarged, schematic view another embodiment of anend-effector assembly disposed in an open configuration, wherein thefirst and second jaw members are spaced apart from one another andpositioned above the third jaw member, in accordance with the presentdisclosure;

FIG. 22B is an enlarged, schematic view of the end-effector assembly ofFIG. 22A showing the first, second and third jaw members in a closedconfiguration in accordance with an embodiment of the presentdisclosure;

FIG. 23 is an enlarged, perspective view of the end-effector assembly ofFIG. 22A shown with tissue disposed below the electrically-conductivetissue-engaging surfaces of the first and second jaw members and tissueoverlying an upper surface of the third jaw member in accordance with anembodiment of the present disclosure; and

FIG. 24 is an enlarged, perspective view of the end-effector assembly ofFIG. 23 showing the first and second jaw members in a closedconfiguration with tissue in compression disposed between theelectrically-conductive tissue-engaging surfaces of the third jaw memberand the electrically-conductive tissue-engaging surfaces of the firstand second jaw members, respectively, shown with tissue in tensionoverlying the upper surface of the third jaw member, in accordance withan embodiment of the present disclosure.

DETAILED DESCRIPTION

Hereinafter, embodiments of surgical instruments and end-effectorassemblies including three jaw members for use in surgical instrumentsto grasp, seal, and/or cut tissue of the present disclosure aredescribed with reference to the accompanying drawings. Like referencenumerals may refer to similar or identical elements throughout thedescription of the figures. As shown in the drawings and as used in thisdescription, and as is traditional when referring to relativepositioning on an object, the term “proximal” refers to that portion ofthe apparatus, or component thereof, closer to the user and the term“distal” refers to that portion of the apparatus, or component thereof,farther from the user.

This description may use the phrases “in an embodiment,” “inembodiments,” “in some embodiments,” or “in other embodiments,” whichmay each refer to one or more of the same or different embodiments inaccordance with the present disclosure.

Various embodiments of the present disclosure provide surgicalinstruments suitable for sealing, cauterizing, coagulating/desiccating,and/or cutting vessels and vascular tissue. Embodiments of thepresently-disclosed surgical instruments with an end-effector assemblyincluding three jaw members may be suitable for utilization inendoscopic surgical procedures and/or suitable for utilization in opensurgical applications. Embodiments of the presently-disclosed surgicalinstruments may be implemented using a variety of types of energy, e.g.,electrosurgical energy at radio frequencies (RF) and/or at otherfrequencies, ultrasonic, optical, and/or thermal energy. Embodiments ofthe presently-disclosed surgical instruments may be configured to beconnectable to one or more energy sources, e.g., RF generators and/orultrasonic generators.

The various embodiments disclosed herein may also be configured to workwith robotic surgical systems and what is commonly referred to as“Telesurgery.” Such systems employ various robotic elements to assistthe surgeon in the operating theater and allow remote operation (orpartial remote operation) of surgical instrumentation. Various roboticarms, gears, cams, pulleys, electric and mechanical motors, etc. may beemployed for this purpose and may be designed with a robotic surgicalsystem to assist the surgeon during the course of an operation ortreatment. Such robotic systems may include, remotely steerable systems,automatically flexible surgical systems, remotely flexible surgicalsystems, remotely articulating surgical systems, wireless surgicalsystems, modular or selectively configurable remotely operated surgicalsystems, etc.

The robotic surgical systems may be employed with one or more consolesthat are next to the operating theater or located in a remote location.In this instance, one team of surgeons or nurses may prep the patientfor surgery and configure the robotic surgical system with one or moreof the instruments disclosed herein while another surgeon (or group ofsurgeons) remotely control the instruments via the robotic surgicalsystem. As can be appreciated, a highly skilled surgeon may performmultiple operations in multiple locations without leaving his/her remoteconsole which can be both economically advantageous and a benefit to thepatient or a series of patients.

The robotic arms of the surgical system are typically coupled to a pairof master handles by a controller. The handles can be moved by thesurgeon to produce a corresponding movement of the working ends of anytype of surgical instrument (e.g., end effectors, graspers, knives,scissors, etc.) which may complement the use of one or more of theembodiments described herein. In various embodiments disclosed herein,an end-effector assembly including three jaw members may be coupled to apair of master handles by a controller. The movement of the masterhandles may be scaled so that the working ends have a correspondingmovement that is different, smaller or larger, than the movementperformed by the operating hands of the surgeon. The scale factor orgearing ratio may be adjustable so that the operator can control theresolution of the working ends of the surgical instrument(s).

The master handles may include various sensors to provide feedback tothe surgeon relating to various tissue parameters or conditions, e.g.,tissue resistance due to manipulation, cutting or otherwise treating,pressure by the three jaw members onto the tissue, tissue temperature,tissue impedance, etc. As can be appreciated, such sensors provide thesurgeon with enhanced tactile feedback simulating actual operatingconditions. The master handles may also include a variety of differentactuators for delicate tissue manipulation or treatment furtherenhancing the surgeon's ability to mimic actual operating conditions.

In FIG. 1, an embodiment of a surgical instrument 10 is shown for usewith various surgical procedures, e.g., endoscopic surgical procedures.Surgical instrument 10 generally includes a housing 60, a handleassembly 30, a rotatable assembly 80, a trigger assembly 70, and anend-effector assembly 91 that mutually cooperate to grasp, seal and/ordivide tissue (e.g., tissue “T” shown in FIG. 3), e.g., tubular vesselsand vascular tissue. End-effector assembly 91 includes a first jawmember 110, a second jaw member 120, and a third jaw member 130 disposedbetween the first and second jaw members 110 and 120, respectively,which are configured to be controllably movable, e.g., to grasp and/orseal tissue.

The first and second jaw members 110 and 120 are configured to becontrollably movable relative to one another and/or relative to thethird jaw member 130, e.g., to control the amount of compression appliedto tissue (e.g., tissue in compression “T_(C)” shown in FIGS. 5 and 6).In some embodiments, the instrument 10 is configured to provide a usercapability to controllably move the first and second jaw members 110 and120 laterally towards the third jaw member 130 to progressively tensiontissue (e.g., tissue in tension “T_(T)” shown in FIGS. 5 and 6)overlying the upper surface 134 of the third jaw member 130.

In some embodiments, as shown in FIGS. 1 through 6, third jaw member 130includes a cutting member 156 disposed along a portion of the uppersurface 134 of the third jaw member 130. As best seen in FIGS. 3 through6, the cutting member 156 includes a cutting edge 158. End-effectorassembly 91 may be configured to allow the cutting member 156 or portionthereof, e.g., the cutting edge 158, to be selectively retractable andextendable through an opening (not shown) defined in the upper surface134 of the third jaw member 130.

Surgical instrument 10 generally includes an elongated shaft 12 defininga longitudinal axis “A-A”. Shaft 12 supports movement of othercomponents therethrough, e.g., to impart movement to the first, secondand third jaw members 110, 120 and 130, respectively. In someembodiments, the trigger assembly 70 is operatively coupled to theend-effector assembly 91, e.g., to allow the surgeon to change theposition and/or orientation of the third jaw member 130.

Although FIG. 1 depicts a surgical instrument 10 for use in connectionwith endoscopic surgical procedures, the teachings of the presentdisclosure may also apply to more traditional open surgical procedures.For the purposes herein, the device 10 is described in terms of anendoscopic instrument; however, an open version of the device may alsoinclude the same or similar operating components and features asdescribed below.

In some embodiments, as shown in FIG. 1, first jaw member 110 and thesecond jaw member 120 are pivotably connected about a pivot pin 103 andcontrollably movable relative to one another and/or relative to thethird jaw member 130, e.g., pivotably movable about the pivot pin 103,in a curvilinear direction “D₁” as shown in FIG. 2A. First jaw member110, the second jaw member 120, and/or the third jaw member 130 may becurved at various angles to facilitate manipulation of tissue and/or toprovide enhanced line-of-sight for accessing targeted tissues. Thefirst, second, and third jaw members 110, 120, and 130, respectively,may be formed from any suitable material or combination of materials byany suitable process, e.g., machining, stamping, electrical dischargemachining (EDM), forging, casting, injection molding, metal injectionmolding (MIM), and/or fineblanking. End-effector assembly 91 may includeone or more electrically-insulative elements to electrically isolate thefirst jaw member 110 from the second jaw member 120. End-effectorassembly 91 may additionally, or alternatively, include one or moreelectrically-insulative bushings to electrically isolate the third jawmember 130 from the first jaw member 110 and/or the second jaw member120.

End-effector assembly 91 may include one or more electrically-conductivetissue-engaging surfaces (also referred to herein as “sealing plates”)coupled to, or otherwise disposed in association with, the first, secondand/or third jaw member 110, 120 and/or 130, respectively. In someembodiments, as shown in FIGS. 2A through 6, end-effector assembly 91includes first and second electrically-conductive tissue-engagingsurfaces 112 and 122, respectively, wherein the firstelectrically-conductive tissue-engaging surface 112 is coupled to, orotherwise disposed in association with, the first jaw member 110, andthe second electrically-conductive tissue-engaging surface 122 iscoupled to, or otherwise disposed in association with, the second jawmember 120. End-effector assembly 91 may include electrically-insulativemembers configured to electrically isolate, at least in part, the firstand second electrically-conductive tissue-engaging surfaces 112 and 122(also referred to herein as “first and second sealing plates 112 and122”) from the first and second jaw members 110 and 120, respectively.In some embodiments, the first and second sealing plates 112 and 122 maybe integrally formed with the first and second jaw members 110 and 120,respectively. End-effector assembly 91 may additionally, oralternatively, include electrically-conductive tissue-engaging surfacescoupled to, or otherwise disposed in association with, the third jawmember 130.

In some embodiments, as shown in FIGS. 2A through 6, the end-effectorassembly 91 additionally includes third and fourth sealing plates 131and 132 coupled to, or otherwise disposed in association with, the thirdjaw member 130, wherein the first and third sealing plates 112 and 131,respectively, are disposed in opposing relation to one another, and thesecond and fourth sealing plates 122 and 132, respectively, are disposedin opposing relation to one another. In some embodiments, theend-effector assembly 91 may be configured to allow the first, second,third and fourth sealing plates 112, 122, 131 and 132 to be separatelyactivated, and/or activated in pairs (e.g., first and third sealingplates 112 and 131 and/or second and fourth sealing plates 122 and 132).

As shown in FIG. 1, the shaft 12 includes a distal end 16 configured tomechanically engage the end-effector assembly 91. In some embodiments,the end-effector assembly 91 is selectively and releasably engageablewith the distal end 16 of the shaft 12. In some embodiments, as shownFIGS. 2A and 2B, shaft 12 includes an outer shaft member 160 and aninner shaft member 180 that is configured for longitudinal motion withrespect to the outer shaft member 160. Inner shaft member 180 isslidingly disposed within the outer shaft member 160 and operable by adrive assembly (not shown). The proximal end 14 of the shaft 12 isreceived within the housing 60 and examples of connections relatingthereto, and examples of drive assembly embodiments of the surgicalinstrument 10, are described in commonly assigned U.S. Pat. No.7,150,097 entitled “METHOD OF MANUFACTURING JAW ASSEMBLY FOR VESSELSEALER AND DIVIDER,” commonly assigned U.S. Pat. No. 7,156,846 entitled“VESSEL SEALER AND DIVIDER FOR USE WITH SMALL TROCARS AND CANNULAS,”commonly assigned U.S. Pat. No. 7,597,693 entitled “VESSEL SEALER ANDDIVIDER FOR USE WITH SMALL TROCARS AND CANNULAS,” and commonly assignedU.S. Pat. No. 7,771,425 entitled “VESSEL SEALER AND DIVIDER HAVING AVARIABLE JAW CLAMPING MECHANISM.”

Surgical instrument 10 includes a cable 310. Cable 310 may be formedfrom a suitable flexible, semi-rigid or rigid cable, and may connectdirectly to an energy source 28, e.g., an ultrasonic and/orelectrosurgical power generating source. In some embodiments, the cable310 connects the surgical instrument 10 to a connector 17, which furtheroperably connects the instrument 10 to the energy source 28. Cable 310may be internally divided into one or more cable leads (not shown) eachof which transmits energy through its respective feed path to theend-effector assembly 91. In some embodiments, cable 310 may includeoptical fiber.

Energy source 28 may be any generator suitable for use with surgicaldevices, and may be configured to provide various frequencies ofelectrosurgical energy, optical energy, and/or ultrasound. Examples ofelectrosurgical generators that may be suitable for use as a source ofelectrosurgical energy are commercially available under the trademarksFORCE EZ™, FORCE FX™, and FORCE TRIAD™ offered by Covidien SurgicalSolutions of Boulder, Colo. Surgical instrument 10 may alternatively beconfigured as a wireless device or battery-powered.

As shown in FIG. 1, the end-effector assembly 91 is rotatable about alongitudinal axis “A-A” through rotation, either manually or otherwise,of the rotatable assembly 80. Rotatable assembly 80 generally includestwo halves (not shown), which, when assembled about the shaft 12, form agenerally circular rotatable member 82. Rotatable assembly 80, orportions thereof, may be configured to house a drive assembly (notshown) or components thereof. Examples of rotatable assembly embodimentsand drive assembly embodiments of the surgical instrument 10 aredescribed in the above-mentioned, commonly-assigned U.S. Pat. Nos.7,150,097, 7,156,846, 7,597,693 and 7,771,425.

Handle assembly 30 includes a fixed handle 50 and a movable handle 40.In some embodiments, the fixed handle 50 is integrally associated withthe housing 60, and the movable handle 40 is selectively movablerelative to the fixed handle 50. Movable handle 40 of the handleassembly 30 is ultimately connected to the drive assembly (not shown).As can be appreciated, applying force to move the movable handle 40toward the fixed handle 50 pulls a drive element (e.g., inner shaftmember 180) proximally to impart movement to the first and second jawmembers 110 and 120 from an open position, wherein the first and secondjaw members 110 and 120 are disposed in spaced relation relative to thethird jaw member 130, to a clamping or closed position, wherein thefirst, second and third jaw members 110, 120 and 130 cooperate to grasptissue therebetween. Examples of handle assembly embodiments of thesurgical instrument 10 are described in the above-mentioned,commonly-assigned U.S. Pat. Nos. 7,150,097, 7,156,846, 7,597,693 and7,771,425.

Surgical instrument 10 includes a switch 200 configured to permit theuser to selectively activate the instrument 10 in a variety of differentorientations, i.e., multi-oriented activation. As can be appreciated,this simplifies activation. When the switch 200 is depressed, energy istransferred through one or more pathways, e.g., electrical leads (notshown) and/or optical fiber (not shown), to the first and second jawmembers 110 and 120. Additionally, or alternatively, when switch 200 isdepressed, energy may be transferred through one or more electricalleads (not shown) to the third jaw member 130. Although FIG. 1 depictsthe switch 200 disposed at the proximal end of the housing assembly 60,switch 200 may be disposed on another part of the instrument 10 (e.g.,the fixed handle 50, rotatable member 82, etc.) or another location onthe housing assembly 60.

FIG. 2A shows the end-effector assembly 91 in an open configurationwherein the first and second jaw members 110 and 120 are disposed inspaced relation relative to the third jaw member 130 disposedtherebetween. First and second jaw members 110 and 120 are controllablymovable with respect to one another and/or with respect to the third jawmember 130, e.g., along a curvilinear direction “D₁”, from an openconfiguration wherein the first and second jaw members 110 and 120 aredisposed in spaced relation relative to the third jaw member 130, to aclamping or closed position, wherein the first, second and third jawmembers 110, 120 and 130 cooperate to grasp tissue therebetween, e.g.,to control the amount of compression applied to tissue (e.g., tissue incompression “T_(C)” shown in FIGS. 5 and 6). When the end-effectorassembly 91 is disposed in an open configuration, the first and secondside surfaces 131 and 132 of the third jaw member 130 are spaced apartfrom the first and second electrically-conductive tissue-engagingsurfaces 112 and 122, respectively.

In FIG. 2B, the third jaw member 130 is shown disposed downwardly at afirst angle, e.g., relative to the longitudinal axis “A-A” defined bythe shaft 12 and/or relative to a plane defined by the upper surfaces114 and 124 of the first and second jaw members 110 and 120,respectively. In some embodiments, the first angle may be an acuteangle, e.g., an angle that measures between 0 degrees and 90 degrees.When the third jaw member is slanted downward, the distal end 137 of thethird jaw member 130 is positioned offset from the longitudinal axis“A-A” defined by the shaft 12, e.g., to provide the surgeon with thecapability to position tissue (e.g., tissue “T” shown in FIG. 3) overthe upper surface 134 of the third jaw member 130.

FIG. 3 shows the end-effector assembly 91, wherein the third jaw member130 is disposed slanted downward at a first angle with tissue “T”, e.g.,tubular vessel, in contact with the first, second, and third jaw members110, 120, and 130. End-effector assembly 91 is configured to allow thesurgeon to position the first, second and third jaw members 110, 120 and130, respectively, in relation to tissue “T”, e.g., wherein portions oftissue “T” are disposed below the lower surfaces 113 and 123 of thefirst and second jaw members 110 and 120 and a portion of tissue “T isdisposed above the upper surface 134 of the third jaw member 130.

FIG. 4 shows the end-effector assembly 91 disposed in an openconfiguration wherein the first and second jaw members 110 and 120 arespaced apart from the third jaw member 130 disposed therebetween.End-effector assembly 91 is configured to allow the surgeon to positionthe first, second, and third jaw members 110, 120, and 130,respectively, into vertical alignment relative to one another, whereinthe upper surfaces 114 and 124 of the first and second jaw members 110and 120 are substantially coplanar with the upper surface 134 of thethird jaw member 130, e.g., as shown in FIGS. 2A and 4. In FIG. 4, thefirst and second electrically-conductive tissue-engaging surfaces 131and 132 of the third jaw member 130 and the first and secondelectrically-conductive tissue-engaging surfaces 112 and 122,respectively, are shown with tissue “T” disposed therebetween, and withtissue “T” overlying the cutting edge 158 of the cutting member 156extending from the upper surface 134 of the third jaw member 130.

FIG. 5 shows the end-effector assembly 91 with the first, second andthird jaw members 110, 120 and 130 in a closed configuration, e.g.,after tissue sealing, wherein sealed tissue in compression “T_(C)” isdisposed between the first and, third sealing plates 112 and 131 of thefirst and third jaw members 110 and 130, respectively, and the secondand fourth sealing plates 122 and 132 of the second and third jawmembers 120 and 130, respectively, with tissue in tension “T_(T)”overlying the cutting edge 158 of the cutting member 156.

In FIG. 6, the end-effector assembly 91 is shown with the first, secondand third jaw members 110, 120 and 130 in a closed configuration, withtissue in compression “T_(C)” disposed between the first and, thirdsealing plates 112 and 131 of the first and third jaw members 110 and130, respectively, and the second and fourth sealing plates 122 and 132of the second and third jaw members 120 and 130, respectively, and withsevered tissue “T_(S)” disposed above the third jaw member 130, e.g.,tissue “T” has been severed into two portions “T_(S)” by the cuttingedge 158.

In some embodiments, the third jaw member 130 includes a channel definedin the upper surface 134 thereof, wherein the channel is disposed incommunication with an interior cavity defined within the third jawmember 130 configured to receive the cutting member 156 therein. Thirdjaw member 130 may be configured with a mechanism to allow for selectiveraising and lowering of the cutting member 156, e.g., from a firstconfiguration wherein the cutting member 156 is disposed within theinterior cavity to a second configuration wherein at least the cuttingedge 158 of the cutting member 156 is disposed above the upper surface134 of the third jaw member 130.

FIGS. 7 through 10 show a portion of an elongated shaft 712 of asurgical instrument, a knife 156 operatively coupled to the shaft 712,and an end-effector assembly 791 disposed at the distal end the shaft712 in accordance with an embodiment of the present disclosure. Knife756 includes a knife bar 757 and a knife blade 758 disposed at thedistal end of the knife bar 757. End-effector assembly 791 includes thefirst and second jaw members 110 and 120 and the first and secondsealing plates 112 and 122 of the end-effector assembly 91 shown inFIGS. 1 through 6, and further description of those features is omittedin the interests of brevity.

End-effector assembly 791 includes a controllably movable third jawmember 730 disposed between the first and second jaw members 110 and120. In some embodiments, the third jaw member 730 is controllablymovable from a first configuration, wherein an upper surface 734 of thethird jaw member 730 is substantially coplanar with the upper surfaces114 and 124 of the first and second jaw members 110 and 120,respectively, to a second configuration, wherein the upper surface 734of the third jaw member 730 is disposed below (or above) a plane definedby the upper surfaces 114 and 124 of the first and second jaw members110 and 120, respectively. In some embodiments, as shown in FIGS. 7through 10, end-effector assembly 791 includes third and fourth sealingplates 731 and 732, respectively, coupled to, or otherwise disposed inassociation with, the third jaw member 730.

In FIG. 7, the end-effector assembly 791 is shown disposed in an openconfiguration wherein the first and second jaw members 110 and 120 arespaced apart from the third jaw member 730 disposed therebetween. Achannel 751 defined along the length of the upper surface 734, orportion thereof, of the third jaw member 730 is configured to slideablyreceive a portion of the knife 756, e.g., a portion including the bottomedge of the knife bar 757. Channel 751 may have any suitable dimensions,e.g., length, width, and depth.

Shaft 712 generally includes a longitudinally-extending interiorpassageway having one or more lumens, channels, etc. definedtherethrough. In some embodiments, as shown in FIGS. 7 through 10, shaft712 includes a longitudinally-extending channel 713 definedtherethrough. The knife bar 757 is configured to be slideablytranslatable through the channel 713 to allow for selective advancementof the knife blade 758. In some embodiments, the end-effector assembly791 may be configured to prevent axial translation of the knife bar 757when the upper surface 734 of the third jaw member 730 is disposed belowa plane defined by the upper surfaces 114 and 124 of the first andsecond jaw members 110 and 120, respectively.

FIG. 8 shows the end-effector assembly 791 disposed in an openconfiguration wherein the third jaw member 730 is disposed slanteddownward at a first angle, e.g., relative to a longitudinal axis definedby the shaft 712 and/or relative to a plane defined by the upperssurfaces 114 and 124 of the first and second jaw members 110 and 120,respectively. In FIG. 8, the end-effector assembly 791 is positionedsuch that portions of tissue “T”, e.g., tubular vessel, are disposedbelow the lower surfaces 113 and 123 of the first and second jaw members110 and 120, respectively, and a portion of tissue “T” is disposed abovethe upper surface 734 of the third jaw member 730.

In FIG. 9, the end-effector assembly 791 is shown with the first andsecond jaw members 110 and 120 in a closed configuration, e.g., aftertissue sealing, with portions of sealed tissue in compression “T_(C)”disposed between the first and third sealing plates 112 and 731 of thefirst and third jaw members 110 and 730, respectively, and the secondand fourth sealing plates 122 and 732 of the second and third jawmembers 120 and 730, respectively, and tissue in tension “T_(T)”disposed overlying the upper surface 734 of the third jaw member 730.FIG. 9 shows the knife 756 in a partially extended configuration,wherein a portion the knife bar 757 is disposed within the channel 751on the upper surface 734 of the third jaw member 730 and the knife blade758 is positioned proximal to the tissue in tension “T_(T)” disposedoverlying the upper surface 734.

FIG. 10 shows tissue in compression “T_(C)” between the first and thirdsealing plates 112 and 731 of the first and third jaw members 110 and730, respectively, and the second and fourth sealing plates 122 and 732of the second and third jaw members 120 and 730, respectively, of theend-effector 791, shown with severed tissue “T_(S)” disposed above thethird jaw member 730. In FIG. 10, the knife blade 758 is disposed in anextended configuration and positioned distal to the severed tissue“T_(S)” and the tissue in compression “T_(C)”. The surgeon may maintainthe end-effector assembly 791 in the closed configuration after tissuesealing and cutting, e.g., to view the severed tissue “T_(S)” toevaluate the integrity of the sealed tissue in compression “T_(C)”.

FIGS. 11 and 12 show a portion of an elongated shaft 1112 of a surgicalinstrument, a knife 1156 operatively coupled to the shaft 1112, a knifecover 1117 protruding outwardly of the outer circumferential surface ofthe shaft 1112, and an end-effector assembly 1191 disposed at the distalend the shaft 1112. A knife cavity 1116 defined by the knife cover 1117may be configured to receive the entire knife 1156 therein.Alternatively, the knife cavity 1116 may be configured to receive aportion, e.g., an upper portion, of the knife 1156 therein.

End-effector assembly 1191 includes the first and second jaw members 110and 120 and the first and second sealing plates 112 and 122 of theend-effector assembly 91 shown in FIGS. 1 through 6, and furtherdescription of those features is omitted in the interests of brevity.End-effector assembly 1191 includes a controllably movable third jawmember 1130 disposed between the first and second jaw members 110 and120.

Third jaw member 1130 is controllably movable from a firstconfiguration, wherein the first, second and third jaw members 110, 120and 1130 are disposed in vertical alignment relative to one another(e.g., an upper surface 1134 of the third jaw member 130 issubstantially coplanar with the upper surfaces 114 and 124 of the firstand second jaw members 110 and 120, respectively), to a secondconfiguration, wherein the upper surface 1134 of the third jaw member1130 is disposed at an angle, e.g., relative to a plane defined by theupper surfaces 114 and 124 of the first and second jaw members 110 and120, respectively. In some embodiments, as shown in FIGS. 11 and 12, theend-effector assembly 1191 includes third and fourth sealing plates 1131and 1132, respectively, coupled to, or otherwise disposed in associationwith, the third jaw member 1130.

In FIG. 11, the end-effector assembly 1191 is shown in an openconfiguration wherein the first and second jaw members 110 and 120 arespaced apart from the third jaw member 1130 disposed therebetween. Achannel 1751 defined along the length of the upper surface 1134 of thethird jaw member 1130 is configured to slideably receive a bottomportion of the knife 1156. Channel 1751 may have any suitabledimensions, e.g., length, width, and depth. An opening 1114 at thedistal end 1115 of the knife cover 1117 is disposed in communicationwith the knife cavity 1116 and configured to allow axial translation ofthe knife 1156. In some embodiments, the end-effector assembly 1191 maybe configured to prevent axial translation of the knife 1156 when theupper surface 1134 of the third jaw member 1130 is disposed below aplane defined by the upper surfaces 114 and 124 of the first and secondjaw members 110 and 120, respectively.

Knife 1156 includes a knife bar 1157 and a knife blade 1158 disposed atthe distal end of the knife bar 1157. Knife 1156 may be operativelycoupled to a drive assembly (not shown) and/or a trigger assembly (notshown). The drive assembly may have any suitable configuration to allowaxial reciprocation of the knife 1156, e.g., to cause movement of theknife blade 1158 from a retracted position within the knife cavity 1116to an extended position outside the knife cavity 1116. In someembodiments, a trigger assembly (not shown) is operatively disposedrelative to a handle for selectively advancing the knife 1156 forcutting tissue along the upper surface 1134 of the third jaw member1130.

As shown in FIG. 12, the movement of the knife blade 1158 to an extendedposition effects the cutting of tissue in tension “T_(T)” disposed overthe upper surface 1134 of the third jaw member 1130. In someembodiments, the knife 1156 is prevented from movement, e.g., in adistal direction, when the third jaw member 1130 is disposed in anangled/slanted (downward or upward) configuration. FIG. 12 shows sealedtissue in compression “T_(C)” between the first and third sealing plates112 and 1131 of the first and third jaw members 110 and 1130,respectively, and the second and fourth sealing plates 122 and 1132 ofthe second and third jaw members 120 and 1130, respectively, whereinsevered tissue “T_(S)” is disposed above the third jaw member 1130, withthe knife blade 1158 positioned distal to the severed tissue “T_(S)”.

FIGS. 13 through 18 show a portion of a surgical instrument including anend-effector assembly 1391. End-effector assembly 1391 includes thefirst and second jaw members 110 and 120 and the first and secondsealing plates 112 and 122 of the end-effector assembly 91 shown inFIGS. 1 through 6, and further description of those features is omittedin the interests of brevity. End-effector assembly 1391 includes acontrollably movable third jaw member 1330 disposed between the firstand second jaw members 110 and 120. In some embodiments, as shown inFIGS. 13 through 17, the end-effector assembly 1391 includes third andfourth sealing plates 1331 and 1332, respectively, coupled to, orotherwise disposed in association with, the third jaw member 1330.

In FIG. 13, the end-effector assembly 1391 is shown with the first andsecond jaw members 110 and 120 in a closed configuration with a thirdjaw member 1330 disposed therebetween. End-effector assembly 1391includes the cutting member 1356 disposed on the upper surface 1334 ofthe third jaw member 1330 and extending outwardly therefrom.End-effector assembly 1391 may include additional, fewer, or differentcomponents than shown in FIGS. 13 through 18, depending upon aparticular purpose or to achieve a desired result. The shape and size ofthe first, second and third jaw members 110, 120 and 1330, respectively,may be varied from the configuration depicted in FIGS. 13 through 18.

In some embodiments, the cutting member 1356 is an ultrasonic memberconfigured to treat tissue, e.g., to transect, dissect and/or coagulatetissue. The ultrasonic member may be operably coupled to an ultrasonictransducer (not shown), which may be supported within the housing of thesurgical instrument and operably coupled to ultrasonic signal generator.

In some embodiments, the cutting member 1356 may have a monopolarcutting edge (not shown) configured to treat tissue, e.g., to transect,dissect and/or coagulate tissue. In such cases, the end-effectorassembly 1391 may be variously configured to provide suitable electricalisolation between the monopolar cutting edge and the jaw third jawmember 1330.

In FIG. 14, the end-effector assembly 1391 is shown in a configurationwherein the first and second jaw members 110 and 120 are disposed inspaced relation relative to the third jaw member 1330 disposedtherebetween. As shown in FIG. 14, the first jaw member 110 includes anupper surface 114 and a bottom surface 113, the second jaw member 120includes an upper surface 124 and a bottom surface 123, and the thirdjaw member 1330 includes an upper surface 1334 and a bottom surface1333.

In FIG. 15, the first and second jaw members 110 and 120 are disposed inspaced relation relative to the third jaw member 1330 as shown in FIG.14, and the third jaw member 1330 is oriented at a downward angle, e.g.,relative to the longitudinal axis “A-A” (FIG. 1) defined by the shaft.In the configuration shown in FIG. 15, the bottom surface of the thirdjaw member 1330 is positioned below a plane defined by the bottomsurfaces 113 and 123 of the first and second jaw members 110 and 120,respectively. Tissue “T” is depicted overlying a portion of the cuttingmember 1356 disposed on the upper surface 1334 of the third jaw member1330.

In FIG. 16, the first and second jaw members 110 and 120 are showndisposed in spaced relation relative to the third jaw member 1330, withportions of tissue “T” disposed between the first and third sealingplates 112 and 1331 of the first and third jaw members 110 and 1330,respectively, and the second and fourth sealing plates 122 and 1332 ofthe second and third jaw members 120 and 1330, respectively, and tissuein tension “T_(T)” overlying a portion of the cutting member 1356disposed on the upper surface 1334 of the third jaw member 1330.

FIG. 17 shows the first and second jaw members 110 and 120 in a closedconfiguration with tissue in compression “T_(C)”, e.g., vascular tissue,between the first and second electrically-conductive tissue-engagingsurfaces 112 and 122, shown with tissue in tension “T_(T)” overlying thecutting member 1356 disposed on the upper surface 1334 of the third jawmember 1330. During a procedure, when the first and second jaw members110 and 120 are disposed in a closed configuration, e.g., to effectivelygrasp tissue “T”, energy is applied via the first, second, third andfourth electrically-conductive tissue-engaging surfaces 112, 122, 1331and 1332 to effect sealing of the tissue in compression “T_(C)”. Oncethe tissue in compression “T_(C)” is sealed, the cutting member 1356 maybe used to transect, dissect and/or coagulate the tissue in tension“T_(T)” overlying the upper surface 1334 of the third jaw member 1330.In FIG. 17, partially-cut tissue in tension “T_(T)” is illustrativelydepicted. In some embodiments, as shown in FIG. 18, the end-effectorassembly 1391 is configured to allow the user to selectively applytension, e.g., upward tension, to the tissue in tension “T_(T)” duringtreatment by the cutting member 1356. In embodiments wherein the cuttingmember 1356 is an ultrasonic member, during a procedure, upward tensionapplied to the tissue in tension “T_(T)” may improve efficiency, e.g.,increase the rate of dissection and/or coagulation, and/or otherwiseimprove the outcome.

In an embodiment shown in FIG. 18, the end-effector assembly 1391 isconfigured to allow the user to effect movement of the third jaw member1330, which changes the orientation of the cutting member 1356 disposedon the upper surface 1334 of the third jaw member 1330, e.g., toselectively apply tension to the tissue in tension “T_(T)” duringtreatment by the cutting member 1356. In FIG. 18, the end-effectorassembly 1391 is shown with tissue in compression “T_(C)” between thefirst and third sealing plates 112 and 1331 of the first and third jawmembers 110 and 1330, respectively, and the second and fourth sealingplates 122 and 1332 of the second and third jaw members 120 and 1330,respectively, and severed tissue “T_(S)” disposed above the uppersurface 1334 of the third jaw member 1330.

FIGS. 19A through 21 show an end-effector assembly 1991 that includes afirst jaw member 1910, a second jaw member 1920, and a third jaw member1930. The first and second jaw members 1910 and 1920 are configured tobe controllably movable relative to one another and/or relative to thethird jaw member 1930, e.g., to control the amount of compressionapplied to tissue (e.g., tissue in compression “T_(C)” shown in FIG.21).

As illustrated in FIGS. 19A and 19B, the first and second jaw members1910 and 1920 are configured to be controllably movable along acurvilinear direction “D₃”, from an open configuration wherein the lowersurfaces 1913 and 1923 of the first and second jaw members 1910 and1920, respectively, are disposed in spaced relation relative to thethird jaw member 1930 (FIGS. 19A and 20), to a clamping or closedposition (FIG. 19B), wherein the first, second and third jaw members1910, 1920 and 1930 cooperate to grasp tissue “T” therebetween.

In some embodiments, as shown in FIG. 20, end-effector assembly 1991includes first and second electrically-conductive tissue-engagingsurfaces 1912 and 1922, respectively, wherein the firstelectrically-conductive tissue-engaging surface 1912 (also referred toherein as “first sealing plate 1912”) is coupled to, or otherwisedisposed in association with, the first jaw member 1910, and the secondelectrically-conductive tissue-engaging surface 1922 (also referred toherein as “second sealing plate 1922”) is coupled to, or otherwisedisposed in association with, the second jaw member 1920. End-effectorassembly 1991 may additionally, or alternatively, include third andfourth electrically-conductive tissue-engaging surfaces 1931 and 1932(also referred to herein as “third and fourth sealing plates 1931 and1932”) coupled to, or otherwise disposed in association with, the thirdjaw member 1930. End-effector assembly 1991 may include any feature orcombination of features of the end-effector assembly embodimentsdescribed above.

FIG. 21 shows the end-effector assembly 1991 in a closed configurationwith tissue in compression “T_(C)”, e.g., vascular tissue, disposedbetween the first and third sealing plates 1912 and 1931 of the firstand third jaw members 1910 and 1930, respectively, and the second andfourth sealing plates 1922 and 1932 of the second and third jaw members1920 and 1930, respectively, and with tissue in tension “T_(T)”overlying the upper surface 1934 of the third jaw member 1930.

FIGS. 22A through 24 show an end-effector assembly 2291 that includes afirst jaw member 2210, a second jaw member 2220, and a third jaw member2230. As shown in FIGS. 22A and 23, end-effector assembly 2291 includesa first electrically-conductive tissue-engaging surface 2212 coupled to,or otherwise disposed in association with, the first jaw member 2210,and a second electrically-conductive tissue-engaging surface 2222coupled to, or otherwise disposed in association with, the second jawmember 2220. End-effector assembly 2291 may additionally, oralternatively, include third and fourth electrically-conductivetissue-engaging surfaces 2231 and 2232 coupled to, or otherwise disposedin association with, the third jaw member 2230. End-effector assembly2291 may include any feature or combination of features of theend-effector assembly embodiments described above. The first and secondjaw members 2210 and 2220 are configured to be controllably movablerelative to one another and/or relative to the third jaw member 2230,e.g., along a curvilinear direction “D₄”, from an open configurationwherein the first and second electrically-conductive tissue-engagingsurfaces 2212 and 2222 of the first and second jaw members 2210 and2220, respectively, are disposed in spaced relation relative to thethird jaw member 2230 (FIGS. 22A and 23), to a clamping or closedposition (FIG. 22B), wherein the first, second and third jaw members2210, 2220 and 2230 cooperate to grasp tissue “T” therebetween.

FIG. 24 shows the first and second jaw members 2210 and 2220 in a closedconfiguration with tissue in compression “T_(C)”, e.g., vascular tissue,therebetween, and with tissue in tension “T_(T)” overlying the uppersurface of the third jaw member 2230. End-effector assembly 2291 mayinclude any feature or combination of features of the end-effectorassembly embodiments described above.

The above-described surgical instruments with an end-effector assemblyincluding three jaw members are configured to allow the surgeon to movefirst and second jaw members from an open position, wherein the firstand second jaw members are disposed in spaced relation relative to athird jaw member disposed therebetween, to a clamping or closedposition, wherein the first, second and third jaw members, cooperate tograsp tissue therebetween. The above-described end-effector assembliesare configured to allow the first and second jaw members to becontrollably movable relative to one another and/or relative to thethird jaw member, e.g., to control the amount of compression applied totissue. The above-described surgical instruments are configured toprovide a user capability to controllably move the first and second jawmembers laterally towards the third jaw member to progressively tensionthe tissue overlying the upper surface of the third jaw member.

The above-described surgical instruments with an end-effector assemblyincluding three jaw members are configured to allow the third jaw memberto be controllably movable from a first configuration, wherein an uppersurface of the third jaw member is substantially coplanar with the uppersurfaces of the first and second jaw members, to a second configuration,wherein the upper surface of the third jaw member is disposed below (orabove) a plane defined by the upper surfaces of the first and second jawmembers.

The above-described surgical instruments with an end-effector assemblyincluding three jaw members may be suitable for sealing, cauterizing,coagulating/desiccating and/or cutting vessels and vascular tissue. Theabove-described surgical instruments with an end-effector assemblyincluding three jaw members may be suitable for utilization inendoscopic surgical procedures and/or suitable for utilization in opensurgical applications. The above-described surgical instruments with anend-effector assembly including three jaw members may be configured foruse with a variety of energy sources.

Although embodiments have been described in detail with reference to theaccompanying drawings for the purpose of illustration and description,it is to be understood that the inventive processes and apparatus arenot to be construed as limited thereby. It will be apparent to those ofordinary skill in the art that various modifications to the foregoingembodiments may be made without departing from the scope of thedisclosure.

What is claimed is:
 1. A surgical device, comprising: an elongated shafthaving an end-effector assembly at a distal end thereof, theend-effector assembly including first, second and third jaw members, thefirst and second jaw members controllably movable from a first position,wherein the first and second jaw members are disposed in spaced relationrelative to the third jaw member disposed therebetween, to a secondposition, wherein the first, second and third jaw members cooperate tograsp tissue therebetween, wherein the first jaw member is movable in afirst direction toward the third jaw member and the second jaw member ismovable in a second direction opposite the first direction toward thethird jaw member to grasp tissue therebetween, and wherein the first,second, and third jaw members are movable to a position where an uppersurface of the third jaw member is coplanar with upper surfaces of thefirst and second jaw members and the upper surface of the third jawmember is disposed above a plane defined by bottom surfaces of the firstand second jaw members; and a knife operatively coupled to the elongatedshaft, wherein a channel defined along a length of the upper surface ofthe third jaw member is configured to slideably receive a portion of theknife therein, wherein the first and second jaw members are configuredto be controllably movable towards the third jaw member to progressivelytension tissue overlying the upper surface of the third jaw member. 2.The surgical device of claim 1, wherein the third jaw member isconfigured to be controllably movable from a first configuration,wherein the upper surface of the third jaw member is coplanar with theupper surfaces of the first and second jaw members, to a secondconfiguration, wherein the upper surface of the third jaw member isdisposed below a plane defined by the upper surfaces of the first andsecond jaw members.
 3. The surgical device of claim 1, furthercomprising first and second electrically-conductive tissue-engagingsurfaces coupled to the first and second jaw members, respectively. 4.The surgical device of claim 3, wherein the first and secondelectrically-conductive tissue-engaging surfaces are adapted to connectto an energy source.
 5. The surgical device of claim 1, wherein theknife includes a knife bar and a blade disposed at a distal end of theknife bar.
 6. The surgical device of claim 5, wherein the channel isconfigured to slideably receive a portion of the knife bar including abottom edge thereof.
 7. An end-effector assembly, comprising: first andsecond jaw members pivotably mounted with respect to one another and athird jaw member disposed between the first and second jaw members, thefirst and second jaw members configured to be controllably movable froma first position, wherein the first and second jaw members are disposedin spaced relation relative to the third jaw member, to a secondposition, wherein the first, second and third jaw members cooperate tograsp tissue therebetween, wherein the first jaw member is movable in afirst direction toward the third jaw member and the second jaw member ismovable in a second direction opposite the first direction toward thethird jaw member to grasp tissue therebetween, and wherein the first,second, and third jaw members are movable to a position where an uppersurface of the third jaw member is coplanar with upper surfaces of thefirst and second jaw members and the upper surface of the third jawmember is disposed above a plane defined by bottom surfaces of the firstand second jaw members; and a channel defined along a length of theupper surface of the third jaw member configured to slideably receive aportion of a knife therein, wherein the first and second jaw members areconfigured to be controllably movable towards the third jaw member toprogressively tension tissue overlying the upper surface of the thirdjaw member.
 8. The end-effector assembly of claim 7, wherein the knifeis selectively movable to cut tissue disposed between the first andsecond jaw members.
 9. The end-effector assembly of claim 7, wherein thethird jaw member is configured to be controllably movable from a firstconfiguration, wherein the upper surface of the third jaw member iscoplanar with the upper surfaces of the first and second jaw members, toa second configuration, wherein the upper surface of the third jawmember is disposed below a plane defined by the upper surfaces of thefirst and second jaw members.
 10. An end-effector assembly, comprising:first and second jaw members pivotably mounted with respect to oneanother and a third jaw member disposed between the first and second jawmembers, the first and second jaw members configured to be controllablymovable from a first position, wherein the first and second jaw membersare disposed in spaced relation relative to the third jaw member, to asecond position, wherein the first, second and third jaw memberscooperate to grasp tissue therebetween, wherein the first jaw member ismovable in a first direction toward the third jaw member and the secondjaw member is movable in a second direction opposite the first directiontoward the third jaw member to grasp tissue therebetween, and whereinthe first, second, and third jaw members are movable to a position wherean upper surface of the third jaw member is coplanar with upper surfacesof the first and second jaw members and the upper surface of the thirdjaw member is disposed above a plane defined by bottom surfaces of thefirst and second jaw members; and a cutting member disposed on the uppersurface of the third jaw member, the cutting member configured to cuttissue disposed between the first and second jaw members, wherein thefirst and second jaw members are configured to be controllably movabletowards the third jaw member to progressively tension tissue overlyingthe upper surface of the third jaw member.
 11. The end-effector assemblyof claim 10, wherein the cutting member outwardly extends from the uppersurface of the third jaw member.
 12. The end-effector assembly of claim11, wherein the cutting member includes a cutting edge.
 13. Theend-effector assembly of claim 10, wherein the cutting member is anultrasonic member configured to treat tissue.
 14. The end-effectorassembly of claim 10, wherein the third jaw member is configured to becontrollably movable from a first configuration, wherein the uppersurface of the third jaw member is coplanar with the upper surfaces ofthe first and second jaw members, to a second configuration, wherein theupper surface of the third jaw member is disposed below a plane definedby the upper surfaces of the first and second jaw members.
 15. Theend-effector assembly of claim 10, wherein the third jaw member isconfigured to be controllably movable from a first configuration,wherein the upper surface of the third jaw member is coplanar with theupper surfaces of the first and second jaw members, to a thirdconfiguration, wherein the upper surface of the third jaw member isdisposed above a plane defined by the upper surfaces of the first andsecond jaw members.